Healthcare Provider Details

I. General information

NPI: 1376349308
Provider Name (Legal Business Name): PAULINA RODRIGUEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4785 N 1ST ST
FRESNO CA
93726-0500
US

IV. Provider business mailing address

1018 CLARA AVE
FOWLER CA
93625-9478
US

V. Phone/Fax

Practice location:
  • Phone: 559-448-4555
  • Fax:
Mailing address:
  • Phone: 559-741-6657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number128682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: